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Clinical practice: evidence-based recommendations for the treatment of Cervical Dystonia with Botulinum Toxin

Cervical dystonia is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for cervical dystonia. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for cervical dystonia based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key-questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of cervical dystonia is well established, robust evidence is still missing concerning some practical aspects, such as doseequivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography (EMG) or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.

What a room! The impact of lactation room quality on breastfeeding mothers

We can work it out:

Research has shown that breastfeeding has important long-term health effects on both children and mothers. The World Health Organization therefore recommends that children be exclusively breastfed for the first six months of life and that breastfeeding be continued thereafter, alongside complementary feeding, until children are at least two years old. However, many mothers experience problems with breastfeeding and stop earlier than they would like. One of the reasons that women stop prematurely is the often difficult combination of breastfeeding and work. In this dissertation Van Dellen studied what organizations can do to support breastfeeding employees, both before the return to work and in the period afterwards.Before the return to work, a breastfeeding support programma appears to be an effective way to support mothers. Within the programme, women received structural support from a lactation consultant, from pregnancy until ten weeks after birth. Mothers who received the support programme were on average 66% less likely to stop breastfeeding compared to mothers who did not receive support. After the return to work, the quality of lactation rooms appears to play an important role. Lactation room quality is positively related to satisfaction, perceived ease, and perceived support for milk expression at work. Moreover, experimental research found that mothers in a high-quality lactation room experienced less stress, more control, and more well-being than mothers in a low-quality lactation room.The results of the study show that organizations can better support breastfeeding employees by offering structural support from a lactation consultant and high-quality lactation rooms.

The impact of lactation room quality in facilitating the combination of breastfeeding and work.

Breastfeeding has important health consequences, not only for infants, but also for mothers (Victora et al., 2016). However, many mothers stop breastfeeding before the advised six month period. Research indicates that difficulties associated with combining work and breastfeeding are an important reason for mothers to discontinue breastfeeding prematurely (Peeters, Lanting, & Van Wouwe, 2015). One important issue in this respect seems to be that in many organizations a lactation room is either lacking or of poor quality. This study examines the relationship between objective and subjective lactation room quality, mood, relaxation, and behavioral determinants of pumping milk at work: attitude, social norms, perceived behavioral control and intention.First, an observation list was developed and pre-tested to determine objective lactation room quality. Then, 511 lactating women completed a questionnaire that included questions about objective and subjective lactation room quality, mood, relaxation, attitude, social norms, perceived behavioral control and intention towards pumping milk at work. Regression analyses showed that both objective and subjective lactation room quality is positively related to mood, relaxation, social norms and perceived behavioral control towards pumping milk at work. Notably mothers’ subjective experience of the room mediated the relationships between objective lactation room quality and mood, relaxation, and social norms and perceived behavioral control. The results of this study show that lactation room quality can potentially impact the process of pumping milk at work in important ways. It is important to further explore the causality of this relationship and its potential effects in experimental settings.

A cross-sectional study of lactation room quality and Dutch working mothers’ satisfaction, perceived ease of, and perceived support for breast milk expression at work

BackgroundThe challenge of combining professional work and breastfeeding is a key reason why women choose not to breastfeed or to stop breastfeeding early. We posited that having access to a high-quality lactation room at the workplace could influence working mothers’ satisfaction and perceptions related to expressing breast milk at work, which could have important longer term consequences for the duration of breastfeeding. Specifically, we aimed to (1) develop a checklist for assessing the quality of lactation rooms and (2) explore how lactation room quality affects lactating mothers’ satisfaction and perceptions. Drawing on social ecological insights, we hypothesized that the quality of lactation rooms (operationalized as any space used for expressing milk at work) would be positively related to mothers’ satisfaction with the room, perceived ease of, and perceived support for milk expression at work.MethodsWe conducted two studies. In Study 1 we developed a lactation room quality checklist (LRQC) and assessed its reliability twice, using samples of 33 lactation rooms (Study 1a) and 31 lactation rooms (Study 1b). Data were collected in the Northern part of the Netherlands (between December 2016 and April 2017). Study 2 comprised a cross-sectional survey of 511 lactating mothers, working in a variety of Dutch organizations. The mothers were recruited through the Facebook page of a popular Dutch breastfeeding website. They completed online questionnaires containing the LRQC and measures aimed at assessing their satisfaction and perceptions related to milk expression at work (in June and July 2017).ResultsThe LRQC was deemed reliable and easy to apply in practice. As predicted, we found that objectively assessed higher-quality lactation rooms were associated with increased levels of satisfaction with the lactation rooms, perceived ease of milk expression at work, and perceived support from supervisors and co-workers for expressing milk in the workplace.ConclusionsThe availability of a high-quality lactation room could influence mothers’ decisions regarding breast milk expression at work and the commencement and/or continuation of breastfeeding. Future studies should explore whether and how lactation room quality affects breastfeeding choices, and which aspects are most important to include in lactation rooms.

Effects of lactation room quality on working mothers’ feelings and thoughts related to breastfeeding and work

BackgroundThe challenging combination of breastfeeding and work is one of the main reasons for early breastfeeding cessation. Although the availability of a lactation room (defined as a private space designated for milk expression or breastfeeding) is important in enabling the combination of breastfeeding and work, little is known about the effects of lactation room quality on mothers’ feelings and thoughts related to breastfeeding and work. We hypothesized that a high-quality lactation room (designed using the Theory of Supportive Design) would cause mothers to experience less stress, have more positive thoughts about milk expression at work, perceive more organizational support, and report more subjective well-being, than a low-quality lactation room.MethodsIn an online randomized controlled trial (Study 1), Dutch mothers (N = 267) were shown either a high-quality or a low-quality lactation room (using pictures and descriptions for the manipulation) and were then asked about their feelings and thoughts. In a subsequent field experiment (Study 2) we modified the lactations rooms in a large organization in Groningen, the Netherlands, to manipulate lactation room quality, and asked mothers (N = 61) who used either a high-quality or low-quality lactation room to fill out surveys to assess the dependent variables.ResultsThe online study showed that mothers exposed to the high-quality lactation room anticipated less stress, more positive cognitions about milk expression at work, more perceived organizational support, and more subjective well-being than mothers exposed to the low-quality lactation room (p <  0.05). Moreover, the effect of lactation room quality on perceived organizational support was especially pronounced for mothers who were higher in environmental sensitivity. The field experiment showed that use of the high-quality room led to less reported stress than use of the low-quality room (p <  0.05). We also found that mothers who were higher in environmental sensitivity perceived more control over milk expression at work and experienced more subjective well-being in the high-quality condition than in the low-quality condition (p <  0.05).ConclusionThe current studies show that not only the availability, but also the quality of lactation rooms is important in facilitating the combination of breastfeeding and work.